Mazza Alberto, Montemurro Domenico, Piccoli Antonio, Pagnan Antonio, Pessina Achille Cesare, Rampin Lucia, Schiavon Laura, Zuin Marco, Rubello Domenico, Zamboni Sergio
Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Blood Press. 2010 Oct;19(5):278-86. doi: 10.3109/08037051003718473.
Glomerular filtration rate (GFR) measured through technetium-99m diethyl triamine penta-acetic acid (Tc(99m)DTPA) renal scintigraphy (rsGFR) was compared with that estimated (eGFR) from 24-h creatinine clearance (CrCl) and, using both the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas, in a population of hypertensive subjects (HTs) with normal serum creatinine (SCr) levels.
In 200 normoalbuminuric (<30 mg/24 h) HTs 55-75 years old, without diabetes and history of coronary and cerebrovascular diseases, Pearson's correlation assess the relationship between rsGFR and eGFR. The Bland-Altman method was used to assess the agreement between rsGFR and eGFR, separately in subjects with low (<60 ml/min/1.73 m(2)) and normal (≥60 ml/min/1.73 m(2)) rsGFR. The span between -1.96 and +1.96 standard deviations of mean difference (bias) was calculated and used for this purpose.
In 76 subjects, an unknown low renal function was found by Tc(99m)DTPA renal scintigraphy. In subjects with normal rsGFR the Bland-Altman analysis showed that the smallest span between rsGFR and eGFR was evident for ClCr values (26.0 ml/min/1.73 m(2)), whereas higher values were detected with the CG and MDRD formulas (41.0 and 40.4 ml/min/1.73 m(2), respectively). The same results were observed for low rsGFR, where a smaller span was found for ClCr (21.2 ml/min/1.73 m(2)), whereas CG and MDRD methods gave greater results (30.4 and 31.8 ml/min/1.73 m(2) respectively); no differences were found between genders. The degree of agreement for eGFR estimated with the CG and MDRD formulas was wider than that derived from ClCr, reflecting a greater between-methods variability and a considerable discrepancy of rsGFR values in the former than in the latter.
In HTs with normal SCr values, Tc(99m)DTPA renal scintigraphy discovered un known renal organ damage in 38% of cases. If this methodology is not available, ClCr measurement should be preferred to estimate GFR whereas CG and MDRD formulas are of limited efficacy.
在血清肌酐（SCr）水平正常的高血压患者（HTs）群体中，将通过锝-99m二乙三胺五乙酸（Tc(99m)DTPA）肾闪烁显像法测得的肾小球滤过率（GFR，rsGFR）与根据24小时肌酐清除率（CrCl）以及使用Cockcroft-Gault（CG）公式和肾脏病饮食改良（MDRD）公式估算的肾小球滤过率（eGFR）进行比较。
在200例年龄55 - 75岁、无糖尿病及冠心病和脑血管疾病史的正常白蛋白尿（<30 mg/24 h）高血压患者中，采用Pearson相关性分析评估rsGFR与eGFR之间的关系。采用Bland-Altman方法分别评估rsGFR较低（<60 ml/min/1.73 m²）和正常（≥60 ml/min/1.73 m²）的患者中rsGFR与eGFR之间的一致性。为此计算并使用了平均差值（偏差）的-1.96至+1.96标准差之间的范围。
通过Tc(99m)DTPA肾闪烁显像法在76例患者中发现了未知的低肾功能。在rsGFR正常的患者中，Bland-Altman分析显示，对于CrCl值（26.0 ml/min/1.73 m²），rsGFR与eGFR之间的最小范围最明显，而使用CG和MDRD公式时检测到的值更高（分别为41.0和40.4 ml/min/1.73 m²）。rsGFR较低的患者也观察到相同结果，CrCl的范围较小（21.2 ml/min/1.73 m²），而CG和MDRD方法得出的结果更大（分别为30.4和31.8 ml/min/1.73 m²）；性别之间未发现差异。用CG和MDRD公式估算的eGFR的一致性程度比CrCl得出的更宽，这反映了前两者方法间的变异性更大，且rsGFR值在前两者中的差异比后者更大。
在SCr值正常的高血压患者中，Tc(99m)DTPA肾闪烁显像法在38%的病例中发现了未知的肾器官损伤。如果无法采用这种方法，应首选测量CrCl来估算GFR，而CG和MDRD公式的有效性有限。
